Ambulance 2009 2010

9 Oct 2009 - The bottom line - Arlington has the ability to significantly improve its level of services within its existing budget. Response times of 2 minutes are far superior to response times of 12 minutes.

Arlington - Ambulance Service

When the Arlington 911 Center receives a call for a serious medical emergency they typically dispatch :

1 Arlington fire truck

1 Arlington police car

the Arlington Fire Department "Rescue 1" truck

1 Armstrong paramedic unit.

The fire truck is staffed by 3 firefighter / EMTs. EMTs (Emergency Medical Technicians) have approximately 100 hours of medical training. The police car is

staffed by 1 police officer who has defibrillator training, and basic first aid training. The Fire Department "Rescue 1"

truck is staffed by 2 firefighter / EMTs. The paramedic unit is staffed by 2 Armstrong Ambulance Service

paramedics. Paramedics have approx 1000 hours of medical training.

Only 'Rescue 1' is capable of transporting a patient on a stretcher to a hospital. None of the other

vehicles can carry a patient on a stretcher. When Rescue 1 takes a party to the hospital, usually one

of the Armstrong paramedics will ride in the Rescue 1 with the patient, and the Rescue 1 EMTs. The other Armstrong paramedic will follow the Rescue 1 in the Armstrong Paramedic unit (SUV).

When a second medical emergency is reported to the Arlington 911 center, they will dispatch a Arlington

fire truck, a Arlington police car, a Armstrong Paramedic unit, and a Armstrong ambulance

(BLS transport unit staffed by 2 Armstong EMTs - Basic Life Support).

If a third medical emergency is reported, the typical response will be - a Arlington fire truck,

a Arlington police car, a Armstrong Paramedic unit, and another Armstrong Ambulance. Once in a blue

moon, an ambulance is requested from Professional Ambulance in Cambridge, Winchester Fire Department,

LifeLine Ambulance Service, maybe the Lexington Fire Department (???), or the Belmont Fire Department.

Armstrong operates a minimum of 3 paramedic units. 'P3' is based in Arlington at the Armstrong HQ

on Mystic St near the Police Station. 'P4' is based at Sancta Maria Hospital (to primarily serve

Belmont & Watertown). 'P1' in Burlington (to primarily serve Burlington & Bedford). P19, P20, P24 etc

are extra Armstrong transport units (they can carry a patient on a stretcher to a hsoptial) that have 2 Armstrong paramedics onboard.

Arlington Police typically have 4 to 6 police cruisers on patrol. All are equipped with

defibrillators to treat cardiac arrests.

Arlington Fire department typically operates the following units :

Arlington Center - Engine 1 with 3 people - Ladder 1 with 3 people - C2 with 1 Deputy Chief

Highland Station near Stop & Shop : Engine 2 with 3 people - Rescue 1 with 2 people

Park Circle : Engine 3 with 3 people. (Almost all of the Arlington firefighters are EMTs)

(All of the pumpers and ladder trucks have first aid kits, defibs, epi pens, oral glucose, and oxygen.)

Response times are typically 3 to 5 minutes for police and fire units - 5 to 7 minutes for the paramedics.

The Arlington 911 dispatchers (? all) have received Emergency Medical Dispatch (EMD) training (this allows them to give medical advice to callers). Dispatch time

is usually expected to be 1 minute. First, the Arlington 911 dispatcher alerts the closest fire station and Rescue 1 via intercom / loudspeaker - then the Arlington 911 dispatcher contacts the Armstrong Ambulance dispatcher and requests a paramedic unit - then a Arlington PD unit is dispatched via radio.

IIRC each ambulance call is billed at approximately $1000. I believe that Armstrong gets the $1000 if they transport the patient; the Town gets the $1000 if Rescue 1 (or Rescue 2) transports the patient to the hospital. There are specific Medicare guidelines that constrain the billing process. It was reported in the Advocate in 2007 that a new 4 year agreement was signed with Armstrong Ambulance. The owner of Armstrong Ambulance (William F Armstrong) has donated large amounts of money to the Town of Arlington (scoreboard at High School, stage for Town Day 2009, etc). 8 Oct 2009 - perhaps the billing arrangement is different now - perhaps Armstrong bills the patient if they provide analysis, treatment, or transport. The Town of Arlington apparently will bill the patient if Rescue 1 takes the patient to a hospital. (Nov 25, 2009 - possibly Medicare rules have been changed in the last few years to allow 2 EMS agencies to submit bills to Medicare for one incident - the paramedic provider can bill for the paramedics services, and the "transport agency" can bill Medicare for taking the patient to a hospital on a stretcher. Possibly the paramedics can also bill medicare if they respond to an incident but just evaluate the patient).

Oct 9 2009 - Patients are typically transported to Winchester Hospital, Lahey Clinic, Mount Auburn Hospital, Cambridge City Hospital, Childrens Hospital, or Lawrence Memorial Hospital in Medford. Severely injured trauma patients are usually transported to Mass General Hospital, Beth Israel Hospital, or Brighams Hospital. (Typically, it requires 15 to 20 to 30 minutes to reach one of the trauma centers - 12 Oct 2009). Psychiatric patients are taken to Cambridge City Hospital usually.

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General ambulance (aka "emergency medical service" (EMS)) information -

http://www.yorkpress.co.uk/news/5085735.Dying_man_is_saved_in_street_in_Walmgate/?ref=rss - York England UK - paramedics respond on bicycles - March 27, 2010

March 5, 2010 - http://statter911.com/2010/03/04/dc-fire-ems-reviews-actions-after-toddler-died-crew-out-of-the-field-while-department-investigates-why-little-girl-was-transported-after-first-call-to-911/comment-page-1/#comment-17053 - being a solo paramedic is not that hard per 1 poster

Feb 24 2010 - http://www.thesunchronicle.com/articles/2010/02/23/news/6979926.txt - Norfolk MA FD ALS has been saving lives for 5 years

Jan 21 2010 - http://www.jems.com/news_and_articles/columns/Heightman/first_response_strategies_revisited.html - this is an overview of EMS in the USA today

January 3, 2010 - http://news.cincinnati.com/article/20091231/NEWS01/1010314/CPR+saved+life++shows+need+for+more - more CPR by bystanders could save 15,000 lives per year in the USA

December 30, 2009 - http://www.boston.com/news/local/breaking_news/2009/12/pentucket_high.html?camp=localsearch:on:twit:metro - Haverhill High School - hockey player collapses and dies

Dec 28, 2009 - http://www.ncbi.nlm.nih.gov/pubmed/18924014 - dangle a carrot in front of a medic, and he will do his job

Dec 27, 2009 - http://naemsp-dialog.googlegroups.com/web/Blackwell-ResponseIntervals-PEC-2009.pdf?_done=%252Fgroup%252Fnaemsp-dialog%253F - ALS is really not effective - study from Charlotte North Carolina - 10 minutes was the response time goal - no difference in outcomes were seen if response time goals were not met

Dec 27, 2009 - http://www.shakopeenews.com/news/general_news/heart_chilling_story-112 - Chaksa Minnesota - CPR, AED, and cooling save 48 yr old male heart attack victim

Dec 24, 2009 - http://www.youtube.com/watch?v=b43oOvGKM3E - video - NYC - perfect example of how it is not always necessary to be blasting sirens

Dec 23, 2009 - http://www.physorg.com/news180708680.html - dispatcher assisted CPR is useful

Dec 19, 2009 - http://www.ncdjpa.org/Communications_Center.html - North County San Diego - dispatch in as little as 12 seconds - average of 30 seconds

Dec 18, 2009 - http://www.ci.sierra-vista.az.us/cms1//resources/Fire/Publications/SOP/Emergency%20Response%20Times%20SOP.pdf - Sierra Vista AZ FD - 45 second turnout time for EMS calls

Dec 13, 2009 - http://thestar.com.my/news/story.asp?file=/2009/12/13/focus/5289589&sec=focus - Singapore may put ambulances "on patrol"

Nov 25, 2009 - http://medicscribe.com/2009/11/oxygen-heresy/ - major news - oxygen may be harmful to heart atack victims

Nov 22, 2009 - http://www.wickedlocal.com/arlington/sports/x2118743777/Soccer-player-in-critical-condition - soccer player stricken at Arlington High School Field - May 2008 - medics delayed 2 minutes by locked gate

Nov 22, 2009 - http://www.boston.com/sports/schools/football/articles/2007/09/23/revered_school_sports_official_dies_of_apparent_heart_attack/ - at Arlington High School Field on Friday Sept 21, 2007

Nov 19, 2009 - http://www.youtube.com/watch?v=3EOEQrLqc0I - May 2008 video about Opticom traffic light preemption systems

Nov 19, 2009 - http://www.co.orange.nc.us/occlerks/0911176a.pdf - this report says that North Carolina has a 90 second response time requirement for ambulances - the report mentions 45 second dispatch time - perhaps they spend 45 seconds on calltaking and dispatch; and then do a 45 second turnout time (chute time)

Nov 8, 2009 - http://www.wickedlocal.com/arlington/news/lifestyle/health/x2013238130 - Armstrong Ambulance moved to new HQ in 2006

Nov 8, 2009 - http://www.nih.gov/news/health/nov2009/nhlbi-06.htm - 2 CPR studies stopped - no improvements seen

Oct 28, 2009 - http://www.emsnetwork.org/artman2/publish/article_39258.shtml - here is a detailed look at an ambulance service in England - 30 seconds is their turnout time goal

Oct 26 2009 - An Inconvenient EMS Truth - http://ambulancedriverfiles.com/2009/10/ems-2-0-an-inconvenient-ems-truth/ - this is a well written 2 page review of the effectiveness of current day ambulances, ERs, and trauma centers

Oct 15 2009 - 55 year old man saved from cardiac arrest in London train station - http://www.londonambulance.nhs.uk/calling_999/emergency_heart_care/cardiac_arrest/real_life_steves_story.aspx

Oct 15 2009 - Per the London Ambulance UK website - London Ambulance utilize "single responders" that travel in cars, motorbikes, and bicycles. Their "emergency ambulances" have two person crews of either EMT or paramedic.

Oct 15 2009 - London Ambulance UK uses "on call" volunteers - http://www.londonambulance.nhs.uk/working_for_us/volunteering_with_us/tony_jenkins_-_ambulance_commu.aspx - response times of 2 minutes is mentioned - (please see the 2 minute defib study below)

Oct 11 2009 - Paris France FD uses 'pumper / ambulances' - http://www.youtube.com/watch?v=sQwgO8jB5YU - that is one right there

Oct 10 2008 - Report on Washington DC Ambulance Service - Sept 2009 - 157 pages - http://www.wusa9.com/news/columnist/blogs/FEMS-Final-ROI%5B1%5D.pdf - this will give you a good inside look at the workings of a big city ambulance service

Oct 10 2009 - Genesee County Michigan wants to equip ambulances with AVL systems (auto vehicle location) - http://www.tctimes.com/articles/2009/10/09/news/doc4accaa4fb4811219921567.txt

Oct 8 2009 - 20 minute ambulance response time in Kirbyville Texas - 49 year old man dies of heart attack - http://www.emsresponder.com/online/article.jsp?siteSection=1&id=10674

Oct 8 2009 - "ALS" is 'advanced life support' (a paramedic giving meds via IV, etc) - "BLS" is "Basic Life Support" (BLS is oxygen, splints, bandages, etc - basic care provided by EMTs)

Oct 8 2009 - basic info about ALS (advanced life support) billing practices - http://connect.jems.com/forum/topics/als-billing-levels

Oct 7 2009 - defibrillation in under 2 minutes is best - http://content.nejm.org/cgi/reprint/358/1/9.pdf - look at 'Results' on page 1 - 40% save rate for under 2 minutes - 20% save rate for over 2 minutes

Oct 7 2009 - Wikipedia article on Ambulances - http://en.wikipedia.org/wiki/Ambulance

Oct 7 2009 - Wikipedia article on Emergency Medical Services - http://en.wikipedia.org/wiki/Emergency_medical_services

Oct 7 2009 - click on the "Emergency Medical Service" video - 9 minutes of general info about the New York City ambulance service - warning - little bit graphic (finger amputation) -

http://www.nyc.gov/html/fdny/media/video/fdny-series/index.shtml

Oct 6 2009 - this document will show you some of the newest treatment procedures -

http://www.jems.com/Images/Philips_Driving_tcm16-215030.pdf

Oct 6 2009 - Germany uses Emergency Doctor Cars -

http://www.youtube.com/watch?v=JePPeAlYlnI

Oct 6 2009 - Munich Germany has paramedics on motorcycles -

http://www.youtube.com/watch?v=BzVKz0P2fWA

http://www.firehouse.com/node/69642 - Fort Dodge Iowa - paramedics will ride with police - 2003

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Oct 5 2009 - Improvements needed for Arlington

1. Hire a parttime quality control expert - Professional Ambulance Service in Cambridge has one - maybe Arlington could hire her

2. Dispatch the police first to all ambulance calls - they do CPR, Heimlich, blood loss control, etc

3. Explore the use of "patrol paramedics" (like London UK Ambulance & Flint Michigan Sheriff)

4. Implement the highest level of medical advice training for 911 dispatchers

5. Increase prevention efforts (in the UK the Fire Depts are working to reduce car crashes)

6. Equip all dispatchers and vehicles with GPS / AVL systems (global positioning system / automatic vehicle location) - this will be a Metro area project - in addition, complete "boundary drop" agreements are needed with all of our neighbors

7. Beef up all disaster plans - hold disaster drills every 2 months

8. Store tape recordings of all radio traffic for 1 year